We reported last month that the U.S. Department of Justice was investigating the risk-adjustment practices of UnitedHealth Group and WellMed Medical Management. At the time, a question remained about whether the DOJ would look into the risk-adjustment or claims-coding activities of other health insurers.
U.S. District Judge Amy Berman Jackson has blocked the merger of Anthem and Cigna, the second court ruling this year against megamergers in the health insurance industry.
On Thursday, Anthem said it would appeal the Feb. 8 ruling promptly and request an expedited hearing. Cigna said it would review the decision and evaluate its options. Anthem has a financial incentive to appeal given that under the terms of the merger proposal, Anthem agreed to pay Cigna $1.85 billion if the deal fell apart. Continue reading
Covering health disparities is not a beat solely for health reporters.
But when those pocketbook stories started drifting into the health realm, Kiel found himself like many other journalists on other beats suddenly digging into the complicated world of medicine, providers and costs. Continue reading
In a case brought by House Republicans, a federal district judge ruled on May 12 that the cost-sharing subsidies are illegal. Congress had never explicitly appropriated those funds. The White House contends that the authority to spend the money is in the ACA statute itself. The judge didn’t buy it. Continue reading
Here’s a story that’s easy to overlook but could affect the future of health care cost and quality management. On Dec. 2,* the U.S. Supreme Court will hear arguments in Gobeille v. Liberty Mutual, a case that could determine whether states can include data from employer-sponsored health plans when compiling information for all-payer claims databases (APCDs).
If you don’t look closely at the case, it may appear to be nothing more than arcane wrangling over whether employers can use a 1974 law to shield themselves from having to share their health insurance data with the public. But it has important implications for the 18 states that have passed laws to develop APCDs, and 20 others that are considering such legislation. Continue reading